achieving meaningful use: public health session 10 april 13, 2011
TRANSCRIPT
Achieving Meaningful Use: Public Health
Session 10
April 13, 2011
Agenda
• Introduction– Overview of how Direct can be used to meet MU requirements
for reporting to public health and immunization registries
• Panelists– Emily Emerson, MIIC Manager/IT Unit Supervisor., Minnesota
Department of Health– Paul Tuten, VP Product Management, ABILITY
• Q&A
• Poll
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Meaningful Use Requirements
Meaningful Use: Stage 1 Final Rule (italics optional Stage 1) and Proposed Objectives for Stages 2 and 3
Stage 1 Final Rule Proposed Stage 2 Proposed Stage 3
Submit immunization data
EH and EP: Mandatory test. Some immunizations are submitted on an ongoing basis to Immunization Information System (IIS), if acceptedand as required by law
EH and EP: Mandatory test. Immunizations are submitted to IIS, if accepted and as required by law. During well child/adult visits, providers review IIS records via their EHR.
Submit syndromic surveillance data Move to core.
Mandatory test; submit if accepted
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State HIE Program Responsibilities
The Program Information Notice to State HIE grantees (dated July 6, 2010) outlined key responsibilities that states and SDEs must address in 2011, specifically to address and enable three priority areas: e-prescribing, receipt of structured lab results, and sharing
patient care summaries across unaffiliated organizations.
Multi-stakeholder process
• Convene public health officials
• Leverage public health agencies to conduct environmental scan
• Perform gap analysis
Monitor/track MU capabilities
• Set baseline, monitor & track meaningful use capabilities in the state• % health
departments electronically receiving immunizations, syndromic surveillance, and notifiable laboratory results
Strategy to fill MU gaps
• Use phased approach
• Help build capacity for public health depts. to accept immunizations, syndromic surveillance, and notifible lab results from providers
• Work with REC to start with gaps among small providers, hospitals, etc.
Consistency with national policies
/standards
• Ensure consistency with national standards, NWHIN specifications, federal policies and guidelines
• Implement a flexible approach
Alignment with Medicaid and public
health
• Establish an integrated approach that represents Medicaid and public health programs
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Why Direct for Public Health?
• MU-compliant. Direct use cases tied to MU priority areas, including public health.
• Standardized. Direct provides a standardized transport mechanism for patient care summaries.
• Simple. Simplicity helps adoption among low volume practices and small, independent providers.
• Scalable. Direct can be utilized beyond 2011 in meeting future stages of meaningful use requirements and other business goals.
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Direct Immunization Data Exchange in Minnesota
• Minnesota Immunization Information Connection (MIIC) Overview
• Public Health Reporting on Immunizations for Meaningful Use
• EHR-IIS Interoperability Grant• Direct Project Participation
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MIIC Interoperability Status
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MIIC Quick Stats
• MIIC is the statewide immunization information system; live since May 2002
• MIIC contains 5.7 million clients/patients• Over 45 million immunizations• 8,324 active users• Over 2,300 log-ins occur every day• Variety of providers enrolled (~3,000)
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Data Exchange in MIIC
• Direct data entry – 14%• Batch file process – 83%
- Batch includes flat file format and HL7 2.3.1 and 2.4.1
• Real-time HL7 – 3%- New standard is 2.5.1
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MIIC and MN State Certified HIOs
• Agreements in place between MDH/MN-HIE and MDH-CHIC
• HIO’s web portal will display IZ of patients based upon MIIC data
• Plans to utilize HL7 real-time messaging
For additional info on Minnesota state certified HIOs, refer to: http://www.health.state.mn.us/e-health/index.html
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Three Paths of EHR-MIIC Integration
• Data from EHR to MIIC “real time”– 2 clinic systems sending real-time HL7
• Ability to query MIIC from within EHR to receive immunization history and forecast– https post– Integrated into three different EHR systems
• True bi-directional exchange– To date, unrealized…
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Meaningful Use and Public Health Reporting for Immunizations
Successful data submissions to MIIC include those with all of the following characteristics:
• Submitted from a certified EHR technology • Follows MIIC HL7 Version 2.3.1 specifications
Capabilities to accept HL7 2.5.1 under development and will be ready in Summer 2011
• Includes MIIC-accepted CVX codes • Sent to MIIC via a secure transport mechanism
Currently it is PHINMS, secure ftp, or direct upload into MIIC, but other options are being explored as part of EHR-IIS interoperability grant
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EHR-IIS Interoperability Grant Minnesota Project Objectives
Project Period: September 2010 – August 2012
• The MDH received $1.38 million in September 2010• Implement HL7 version 2.5.1 messaging for receiving
immunizations records into MIIC• Establish a secure, more automated standard method of
exchanging HL7 messages• Increase the number of electronic interfaces between
EHRs and MIIC • Enhance the capability of MIIC to meet the public health
requirements of meaningful use related to immunizations
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Direct Project Evolution
• Initial meeting of interested stakeholders at MDH (MIIC, OHIT and ISTM) with HISP Vendor (formerly Visionshare, now ABILITY) in Sep 2010
• To meet current message transport environment that MDH supports, decision to use secure PHINMS communication standard as destination edge protocol
• Provider recruitment done by HISP vendor and Hennepin County Medical Center (HCMC) participated in Direct pilot project
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Direct Project Evolution, continued…
• Technical details of transport protocols worked between HISP vendor and technical teams of sender and receiver
• Project went live on January 12, 2011• Currently, HCMC is sending production immunization
data to the MIIC immunization registry using direct project specifications and using PHINMS as destination protocol, a one direction push of data
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Direct Public Health Immunization Pilot Architecture
Source: Adapted from Direct Project site
http://wiki.directproject.org/Pilot+Project+Brief+-+VisionShare+and+Public+Health 16
Future Directions
• Increasing provider participation and moving to better electronic exchange with nationally recommended transport standards
• Increasing timeliness and completeness of immunization reporting
• Advanced reports such as assessment and patient follow up available to end users
• True bi-directional exchange!
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Acknowledgements –True Team Effort!
MDH Leadership•Marty LaVenture, Director, e-Health and Office of Health IT•Jim Golden, State Government HIT Coordinator•John Paulson, MDH Chief Information Officer•Kris Ehresmann, Director, IDEPC•Margo Roddy, IDEPC/Immunization Program Mgr
MIIC Team: Aaron Bieringer, Steve Felton, Diana Jaeger, Linda Luebchow, Priya Rajamani, Erin Roche, Linda Stevens, Karen White, Jeff Williams
ISTM Team: Mark Hollock, Gerry Skerbitz, Keith Hammel, Spencar McCaa
HP: David Kaiser, Mike Loula
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Minnesota Pilot
Internet
Sends Batch Flat Fileof Immunizations
(Will Migrate to HL7 VXU)
ABILITY NetworkSecure Data Facility
Internet
MDH / MIIC
Receives Direct MessageRoutes thru PHINMS “Gateway” Receives via PHINMS Edge Protocol
Stores in MIIC Registry
HCMC
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Have a different HISP?
Internet
ABILITY NetworkSecure Data Facility
Internet
MDH / MIIC
HCMC
Provider
HISP #2
Continues to Receive Direct MessageRoutes thru PHINMS “Gateway” Provider w/ a Different HISP
Sends Direct Message to MDH
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Unable to generate HL7 VXU?
Internet
HISPs can Provide Integration and/or Content Translation Services, Locally or “In The Cloud”
HISP
Internet
Public Health AgencyProvider
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Don’t have an EMR yet?
Internet
ABILITY NetworkSecure Data Facility
Internet
Public Health Agency
Hosted Web Application(s) to Generate HL7 VXU Message… and more.
Provider
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Immunization Reporting “App”
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E-Mail Interface
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Patient Involvement via PHRs
Internet
ABILITY NetworkSecure Data Facility
Internet
Public Health Agency
Provider
Provider
PHR
Routes Direct Message to Both Recipients:Public Health Agency & Patient PHR Receives Message;
Stores and Displays for Patient
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PHR (w/ HL7 VXU Support)
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Lessons Learned (HISP View)
• Default to Direct for Provider-to-DoH Exchange– Benefits from universal addressing, bi-directional
routing, and bi-directional PKI security– Providers a single, uniform edge on the DoH side
• Meet Providers Where They Are At– Direct is flexible w/ respect to edge protocols– HISPs should provide a range of options to meet
providers’ needs and offer an upgrade path
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Nirvana (or nearly)?
HISP B
DoH
Provider A
HISP AProvider B
Provider C
Patient PHR Provider
REST
sFTP
SOAPWeb AppDirect (SMTP)
Direct (SMTP) BackboneSingle Protocol;
DoH Choice
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Additional Direct Pilots w/ Public Health
• Redwood MedNet– Immunization Reporting
• Health Information Network of South Texas– Immunization Reporting
• Information available at:http://wiki.directproject.org/Implementation+Geographies
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Q&AEmily J. Emerson
MIIC Manager/IT Unit SupervisorMinnesota Department of Health
Paul M. Tuten, Ph.D.Vice President, Product Management
ABILITY Network Inc.612.460.4372
Poll
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